The most prevalent issue in physical therapy is pain. Due to the
subjective nature of pain, assessment tools are essential in understanding it
as objective data. However, assessment of pain may result in distress for the
patient. A physical therapist (PT) should conduct these tests as quickly and
accurately as possible. Straightforward instructions are vital in such cases.
This study aimed to clarify the effect of verbal instructions for pain
assessment during a passive straight leg raise (PSLR) test for participants
with chronic low back pain (CLBP). This study included 22 participants who provided
informed consent and received three consecutive PSLR tests with measurement of
the hip flexion range of motion (HFROM) and were instructed to cease the test
at submaximal pain before the first test. Following the second and third tests,
participants were given specific verbal instructions to remember pain
intensity, quality, and location. After each test, participants were to circle
the pain location on the body chart and rate their pain intensity on a numeric
rating scale (NRS) and pain quality. All participants were then interviewed
about the differences between having and not having specific verbal
instructions. The results of HFROM, NRS, and pain extent were not significantly
different between the first and second tests or between the second and third
tests using a paired t-test. Eleven changes in pain location were found in the
second test compared to those in the first test. In the third test, only three
participants circled a different area than in the second test. Ten participants
showed similar changes with pain location in pain quality in the three PSLR
tests. This study revealed the effect of specific verbal instructions prior to
PSLR tests. Particularly, participants could notice exact pain location. Our
findings may help PT to understand pain cause and reduce patients’ stress
during pain assessment in clinical settings.
References
[1]
Ministry of Health, Labour and Welfare (2000) Summary Report of Comprehensive Survey of Living Conditions 2019.
https://www.mhlw.go.jp/english/database/db-hss/dl/report_gaikyo_2019.pdf
[2]
Andou, M. (2000) Assessment of Pain in Physical Therapy. Rigakuryoho Kagaku, 15, 63-72. https://doi.org/10.1589/rika.15.63
[3]
Yo, K. (2020) Assessment and Outcome Index of Physical Therapy for Locomotive Organ Disorders: To the Patients with Cervical Spine Disorders. Journal of the Japanese Physical Therapy Association, 47, 289-296.
[4]
El-Tallawy, S.N., Nalamasu, R., Salem, G.I., LeQuang, J.A.K., Pergolizzi, J.V. and Christo, P.J. (2021) Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain and Therapy, 10, 181-209.
https://doi.org/10.1007/s40122-021-00235-2
[5]
Jull, G., et al. (2015) Grieve’s Modern Musculoskeletal Physiotherapy. 4th Edition, Elsevier, Amsterdam.
[6]
Fillingim, R.B., Loeser, J.D., Baron, R. and Edwards, R.R. (2016) Assessment of Chronic Pain: Domains, Methods, and Mechanisms. The Journal of Pain, 17, T10-T20.
https://doi.org/10.1016/j.jpain.2015.08.010
[7]
Salaffi, F., Ciapetti, A. and Carotti, M. (2012) Pain Assessment Strategies in Patients with Musculoskeletal Conditions. Reumatismo, 64, 216-229.
https://doi.org/10.4081/reumatismo.2012.216
[8]
Ikeya, M., Jiroumaru, T., Bunki, H. and Oka, Y. (2020) Effect of with and without Verbal Instruction for Pain Assessment: During Straight Leg Raising Test. Physical Therapy Koto. The Journal of Shiga Physical Therapist Association, 41, 53-57. (In Japanese)
[9]
Mustajoki, M., Forsén, T. and Kauppila, T. (2018) Pain Assessment in Native and Non-Native Language: Difficulties in Reporting the Affective Dimensions of Pain. Scandinavian Journal of Pain, 18, 575-580. https://doi.org/10.1515/sjpain-2018-0043
[10]
Kitahara, M. (2009) Assessment of Pain: Importance and Pitfalls. The Journal of Japan Society for Clinical Anesthesia, 29, 152-159. https://doi.org/10.2199/jjsca.29.152
[11]
Oliver, G.S. and Rushton, A. (2011) A Study to Explore the Reliability and Precision of Intra and Inter-Rater Measures of ULNT1 on an Asymptomatic Population. Manual Therapy, 16, 203-206. https://doi.org/10.1016/j.math.2010.05.009
[12]
Leoni, D., Falla, D., Heitz, C., Capra, G., Clijsen, R., Egloff, M., et al. (2017) Test-Retest Reliability in Reporting the Pain Induced by a Pain Provocation Test: Further Validation of a Novel Approach for Pain Drawing Acquisition and Analysis. Pain Practice, 17, 176-184. https://doi.org/10.1111/papr.12429
[13]
Herrington, L., Bendix, K., Cornwell, C., Fielden, N. and Hankey, K. (2008) What Is the Normal Response to Structural Differentiation within the Slump and Straight Leg Raise Tests? Manual Therapy, 13, 289-294.
https://doi.org/10.1016/j.math.2007.01.013
[14]
Koo, T.K. and Li, M.Y. (2016) A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of Chiropractic Medicine, 15, 155-163. https://doi.org/10.1016/j.jcm.2016.02.012
[15]
Wenngren, A. and Stålnacke, B.M. (2009) Computerized Assessment of Pain Drawing Area: A Pilot Study. Neuropsychiatric Disease and Treatment, 5, 451-456.
https://doi.org/10.2147/NDT.S5494
[16]
Margolis, R.B., Chibnall, J.T. and Tait, R.C. (1988) Test-Retest Reliability of the Pain Drawing Instrument. Pain, 33, 49-51.
https://doi.org/10.1016/0304-3959(88)90202-3
[17]
Petty, N.J. and Ryder, D. (2018) Musculoskeletal Examination and Assessment: A Handbook for Therapists. 5th Edition, Elsevier, London.
[18]
Smart, K.M., Blake, C., Staines, A., Thacker, M. and Doody, C. (2012) Mechanisms-Based Classification of Musculoskeletal Pain: Part 2 of 3: Symptoms and Sign of Peripheral Neuropathic Pain in Patients with Low Back (±Leg) Pain. Manual Therapy, 17, 345-351. https://doi.org/10.1016/j.math.2012.03.003
[19]
Breivik, H., Borchgrevink, P.C., Allen, S.M., Rosseland, L.A., Romundstad, L., Breivik Hals, E.K., et al. (2008) Assessment of Pain. British Journal of Anaesthesia, 101, 17-24. https://doi.org/10.1093/bja/aen103
[20]
Holdcroft, M. and Power, I. (2003) Management of Pain. The British Medical Journal, 326, 635-639. https://doi.org/10.1136/bmj.326.7390.635
[21]
Barbero, M., Moresi, F., Leoni, D., Gatti, R., Egloff, M. and Falla, D. (2015) Test-Retest Reliability of Pain Extent and Pain Location Using a Novel Method for Pain Drawing Analysis. European Journal of Pain, 19, 1129-1138.
https://doi.org/10.1002/ejp.636
[22]
Takata, K. and Hirotani, H. (1995) Pain Drawing in the Evaluation of Low Back Pain. International Orthopaedics, 19, 361-366. https://doi.org/10.1007/BF00178350
